Health Care System and Economics of Health Care Discussion

Chapter 10 Policy, Politics, Legislation, and Community Health Nursing Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Nurses Who Made a Difference… ⬤ ⬤ ⬤ ⬤ ⬤ ⬤ ⬤ ⬤ ⬤ Florence Nightingale Sojourner Truth Clara Barton Lavinia Dock Lillian Wald Mary Breckenridge Susie Walking Bear Yellowtail Florence Wald Ruth Watson Lubic Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Nurses’ Historical and Current Activity in Health Care Policy ⬤ Florence Nightingale ➢ ➢ ➢ ➢ First nurse to exert political pressure on a government Transformed military health Knew the value of data in influencing policy Collected and analyzed data about health services and outcomes, which now is a critical element of public health Photo credit: http://commons.wikimedia.org/wiki/Flo rence_Nightingale Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Nurses’ Historical and Current Activity in Health Care Policy (Cont.) ⬤ Sojourner Truth ➢ Advocate for abolishing slavery ➢ Supported women’s rights ➢ Helped transform racist and sexist policies that limited health and well-being of blacks and women ➢ Fought for human rights ➢ Lobbied for funds to educate nurses and physicians Photo credit: http://commons.wikimedia.org/wiki/Fil e:Carte_de_visite.jpg Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Nurses’ Historical and Current Activity in Health Care Policy (Cont.) ⬤ Clara Barton ➢ Organized relief efforts during U.S. Civil War ➢ Persuaded Congress to ratify the Treaty of Geneva, which allowed the Red Cross to perform humanitarian efforts in times of peace Photo credit: http://commons.wikimedia.org/wiki/File: WcbbustCBarton.jpg Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Nurses’ Historical and Current Activity in Health Care Policy (Cont.) ⬤ Lavinia Dock ➢ Prolific writer and political activist ➢ Campaigned to allow nurses to control the nursing profession ➢ Advocated for women’s right to vote ➢ Worked closely with Isabel Hampton Robb and Mary Adelaide Nutting to found forerunner to NLN Photo credit: http://commons.wikimedia.org/wiki/File:L avinia_Lloyd_Dock.jpg Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Nurses’ Historical and Current Activity in Health Care Policy (Cont.) ⬤ Lillian Wald ➢ Recognized connection between health and social conditions ➢ Health Care System and Economics of Health Care Discussion

Advocate for development of the Children’s Bureau in 1912 ➢ Frequently appeared at White House in development of national and international policy Photo credit: http://commons.wikimedia.org/wiki/File:Lillian_Wa ld_-_William_Valentine_Schevill.jpg Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Nurses’ Historical and Current Activity in Health Care Policy (Cont.) ⬤ Mary Breckenridge ➢ Developed nursing in rural Kentucky ➢ Established Frontier Nursing Service Photo credit: http://commons.wikimedia.org/wiki/File:WENDOV ER.jpg Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Nurses’ Historical and Current Activity in Health Care Policy (Cont.) ⬤ Florence Wald ➢ Nursing leader in establishing hospice care in the United States ➢ Modeled hospice after similar services offered in United Kingdom Photo credit: http://commons.wikimedia.org/wiki/File: Hospice_Media_Logo.png Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Nurses’ Historical and Current Activity in Health Care Policy (Cont.) ⬤ Susie Walking Bear Yellowtail ➢ Walked from reservation to reservation to improve health services for Native Americans ➢ Established Native American Nurses Association Photo credit: http://commons.wikimedia.org/wiki/F ile:Ketchican_totem_pole_2.jpg Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Nurses’ Historical and Current Activity in Health Care Policy (Cont.) ⬤ Ruth Watson Lubic ➢ Nurse-midwife who crusaded for freestanding birth centers in the United States ➢ Leader in communitybased birth center movement Photo credit: http://commons.wikimedia.org/wiki/File:Silve rton_Hospital_birth_center__Silverton,_Oregon.JPG Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Definitions to Know ⬤ ⬤ ⬤ ⬤ ⬤ ⬤ Social justice Laws Public health law Statutes Organizations Professional associations ⬤ ⬤ ⬤ ⬤ ⬤ ⬤ ⬤ Policy Public policy Health policy Nursing policy Institutional policies Organizational policies Social policy Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Definitions ⬤ ⬤ Policy denotes a course of action to be followed by a government, business, or institution to obtain a desired effect. Public policy denotes precepts and standards formed by governmental bodies (legislative, executive, or judicial) that are of fundamental concern to the state and the whole of the general public. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Definitions (Cont.) ⬤ ⬤ ⬤ Health policy is a statement of a decision regarding a goal in health care and a plan for achieving that goal. Nursing policy specifies nursing leadership that influences and shapes health policy and nursing practice. Institutional policies are rules that govern worksites and identify the institution’s goals, operation, and treatment of employees. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Definitions (Cont.) ⬤ ⬤ Organizational policies are rules that govern organizations and their positions on issues with which the organization is concerned (Mason et al., 2007). Social policy is policy associated with individuals and communities. In very general terms, social policy can be defined as the branch of public policy that advances social welfare and enhances participation in society. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Definitions (Cont.) ⬤ ⬤ ⬤ Laws are rules of conduct or procedure; they result from a combination of legislation, judicial decisions, constitutional decisions, and administrative actions. Public health law focuses on legal issues in public health practice and on the public health effects of legal practice. Public health law typically has three major areas of practice: police power, disease and injury prevention, and the law of populations. Statutes are any laws passed by a legislative body at the federal, state, or local level. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Definitions (Cont.) ⬤ ⬤ Health Care System and Economics of Health Care Discussion

Organizations are associations that set and enforce standards in a particular area; a group of individuals who voluntarily enter into an agreement to accomplish a purpose. A professional association is a nonprofit organization seeking to further a particular profession, the interests of individuals engaged in that profession, and the public interest. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Policy is based on values, and the first step in forming policy is identification of the issue. Therefore, it would seem rational to define “health” as the starting point for any policy annexed to health care issues. Many Healthy People 2020 objectives directly or indirectly involve health policy. – Nies and McEwen, 2015 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Shifts in Philosophy at the CDC From… To… Disease orientation Health protection focus Designing and implementing sponsored programs Informing and guiding health system actors Allocating agency resources Leveraging resources to steer larger health system Emphasis on clinical prevention Focus on prevention and health protection Transaction-based relationships Partnerships and strategic alliances Program requirements Incentives for participation/cooperation Collecting and analyzing health data Creating integrated health information systems Issuing advisories and guidelines Building decision-support system From Centers for Disease Control and Prevention: State of the CDC: fiscal year 2008, The Author. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Healthy People 2020 ⬤ Vision ➢ ⬤ A society in which all people live long, healthy lives. Overarching Goals 1. 2. 3. 4. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Overview of Health Policy ⬤ Public Health Policies ➢ Decisions made at all levels of government (local, state, or federal) ➢ Influence health care through monitoring, production, provision, and financing of health care services ➢ Everyone is affected, from providers to consumers ➢ Influence all health care organizations Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Overview of Health Policy (Cont.) ⬤ Public Health System ➢ Authority for public health vested with states ➢ Responsibility delineated by constitution ➢ Compliance with federal program standards is voluntary but impacted by revenue ➢ Policies influenced by social and political theories ➢ Economics is one factor in decision making ➢ Decisions are slow and deliberate and more reactive ➢ Needs determined by voting shifts, electoral realignment, and term limits Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Overview of Health Policy (Cont.) ⬤ Health Care System and Economics of Health Care Discussion

Private Health Sector ➢ Includes employers, professional organizations, nonprofit health care organizations, and for-profit corporations that deliver, insure, or fund health care services outside of government control ➢ Policies evolve differently—influenced by economics and business management ➢ Economics is central factor in decision making ➢ Decisions are swift and proactive ➢ Needs determined by consumerism, market trends, and economics Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 How a Bill Becomes a Law Figure 10-1. From publicdomainclip-art.blogspot.com/2007_09_01_archive.html. Retrieved October 19, 2009. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Impact of Federal Legislation on Health Care ⬤ ⬤ ⬤ ⬤ ⬤ ⬤ Prevention of illness by influencing the environment Provision of funding to support programs that influence health care Increased the involvement of state and local governments in health care Promoted similarities of services in all states Funding resulted in increased regulations Standardized U.S. public health policy Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Critical Federal Legislation Related to Health Care ⬤ Pure Food and Drug Act of 1906 ➢ Manufacturing, ⬤ labeling, and sale of food Children’s Bureau Act of 1912 ➢ Regulated unhealthy child labor practices ➢ Shepherd-Towner Act in 1921 extended to infants ⬤ Social Security Act of 1935; 1965; 1972 ➢ Benefits for mothers, children, elderly, disabled Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Critical Federal Legislation Related to Health Care (Cont.) ⬤ Medicare (Title XVIII) in 1965 ➢ Health care services for people over 65, with permanent disabilities, and those with end-stage renal disease ⬤ Medicaid (Title XIX) in 1965 ➢ Combined federal and state program ➢ Access to care for poor and medically needy Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Critical Federal Legislation Related to Health Care (Cont.) ⬤ Public Health Act of 1944 ➢ Consolidated all existing public health legislation into one law • Health services for migratory workers • Family planning services • Health research facilities • National Institute of Health (NIH) • Nurse training acts • Traineeships for graduate students in public health • Home health services for Alzheimer’s disease patients • Prevention and primary care services • Rural health clinics • Communicable disease control Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Critical Federal Legislation Related to Health Care (Cont.) ⬤ McCarren-Ferguson Act of 1945 ➢ Gave ⬤ states right to regulate insurance plans Hill-Burton Act of 1946 ➢ Federal assistance in construction of hospitals with stipulations about service for the uninsured ⬤ Health Amendments Act of 1956; Title II ➢ Funds for RN education in administration, supervision, and teaching ➢ 1964 Nurses Training Act: funds for loans and scholarships and to develop more nursing schools Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Critical Federal Legislation Related to Health Care (Cont.) ⬤ Occupational Safety and Health Act of 1970 ➢ Focused on health needs and risks in workplace and environment ⬤ Health Maintenance Organization Act of 1973 ➢ Employers must offer federally qualified HMOs as health care option to employees ➢ States had oversight on HMOs Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Critical Federal Legislation Related to Health Care (Cont.) ⬤ National Health Planning and Resources Act of 1974 ➢ Assigned responsibility for health planning to states and local health system agencies ➢ Required health care facilities to obtain prior approval for expansion in form of Certificate of Need (CON) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 Critical Federal Legislation Related to Health Care (Cont.) ⬤Health Care System and Economics of Health Care Discussion

Omnibus Budget and Reconciliation Acts ➢ 1981, 1987, 1989, and 1990 ➢ Enacted to reduce huge federal deficit ➢ Impacted funding for nursing homes, home health agencies, and hospitals ➢ Established new guidelines and regulations including a move from process to outcome evaluation, use of restraints, and prescription drugs for Medicaid recipients Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Critical Federal Legislation Related to Health Care (Cont.) ⬤ Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) ➢ Amendment to SSA of 1935 ➢ Established PPS for Medicare, the DRG system ⬤ COBRA of 1985 ➢ Requires all EDs that participate in Medicare to provide care for all, regardless of ability to pay ➢ Ensures continuation of insurance after loss of job ➢ Example of how federal government can affect state health care practices Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Critical Federal Legislation Related to Health Care (Cont.) ⬤ Family Support Act of 1988 ➢ Expanded coverage for poor women and children ➢ Expanded Aid to Families with Dependent Children (AFDC) ⬤ Health Objectives Planning Act of 1990 ➢ Response to the first Healthy People report (1979) ➢ United States began to identify and monitor national health goals; Healthy People 2000, 2010, and 2020 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Critical Federal Legislation Related to Health Care (Cont.) ⬤ Health Insurance Portability and Accountability Act (HIPAA) of 1996 ➢ Ensured portability of insurance coverage ➢ Offered protection for patient privacy and confidentiality ⬤ Welfare Reform Act of 1996 ➢ Restricted eligibility for AFDC, Medicaid, etc. ➢ TANF helped move recipients into work; welfare offered temporary assistance ➢ Many underserved lost Medicaid coverage Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Critical Federal Legislation Related to Health Care (Cont.) ⬤ The State Child Health Improvement Act (SCHIP) of 1997; 2009 ➢ Provides insurance for children and families who cannot afford health insurance ⬤ Medicare Modernization Act of 2003 ➢ Most significant law in 40 years for senior health care ➢ Provides seniors and disabled with some Rx drug benefit coverage, more choice, and better benefits Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Critical Federal Legislation Related to Health Care (Cont.) ⬤ Nurse Reinvestment Act of 2003 ➢ Funding provided to increase enrollments and number of practicing nurses ⬤ Mental Health Parity and Addictions Equity Act of 2008 ➢ Financial requirements (deductibles, co-payments) and treatment limitations (number of visits; days of coverage) that apply to mental health benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 37 Critical Federal Legislation Related to Health Care (Cont.) ⬤ Patient Protection and Affordable Care Act of 2010 ➢ All U.S. citizens and legal residents to have qualifying health coverage ➢ Changes eligibility requirements for Medicaid and expands CHIPS ➢ Subsidizes premiums for lower and middle income families ➢ Requires coverage of dependent adult children up to age 26 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 38 Critical Federal Legislation Related to Health Care (Cont.) ⬤ Patient Protection and Affordable Care Act of 2010 (Cont.) ➢ Significant • • • • • insurance reforms Established high-risk pools Covers preexisting conditions No lifetime limits on coverage Cannot drop policyholders when they get sick Must provide preventive care and screenings without customer cost-sharing ➢ Fosters nonprofit, member-run exchanges ➢ Implemented over several years Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 39 Critical Federal Legislation Related to Health Care (Cont.) ⬤ Patient Protection and Affordable Care Act of 2010 (Cont.) ➢ Funded through new fees and taxes. • Taxes on indoor tanning • Medicare taxes for higher income brackets • Fees for pharmaceutical companies and medical devices • Penalties for those who do not obtain health insurance ➢ Cost-cutting measures • Cuts to Medicare Advantage programs • Reductions in Medicare spending • Reduce administrative costs, streamline care, reduce fraud and abuse Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 40 The health reform legislation in 2010 was strongly influenced by the rising number of uninsured and underinsured. The United States is only major developed country to not have universal health coverage. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 41 State Legislative Role Focus on financing and delivery of services and oversight of insurance to address the mission of public health